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What Ails the Health Sector – Challenges and Solutions

With a population of over 1.3 billion, India has the second-largest population in the world. Despite an average birth rate of 18.6 per thousand inhabitants and a rising life expectancy of 69 years, challenges remain in the healthcare sector, particularly in rural areas. While infant mortality rates have declined due to better maternal and child care, communicable and non-communicable diseases have increased and now account for 60% of deaths.

Female infanticide and gender-selective abortions have also decreased since their criminalization. Although the healthcare industry has grown rapidly, with an estimated worth of $280 billion by 2020, it still faces significant challenges in providing affordable and accessible healthcare to the country’s vast population.

India’s Healthcare Sector Challenges

India's Covid-19 vaccination..
India’s Covid-19 vaccination

1. Not Enough Funds Go to Healthcare

According to statistics from 2014, India spends only about 4% of its GDP on healthcare whereas the US allocates about 100 times more. Due to this, 60% of medical expenses of Indians were met through personal savings compared to only 13% in the US.

2. Inequality in Urban and Rural Facilities

In India, unlike other countries, the urban vs. rural divide is huge. Because the spending power is more by people in cities and towns, all healthcare services are diverted only to this sector leaving the rural areas lacking in medical facilities. Over 60% of hospitals, 70% of dispensaries and 80% of well-trained and qualified doctors and health professionals operate mostly in the urban areas. 

3. Inadequate Infrastructure

The ratio of doctors, hospital beds, nurses to the number of patients is alarming. There is one bed for every 2000 patients, one doctor for over 10000 people in a government hospital. There is one state-run hospital for every 90000 people. These numbers are disappointing when compared to those of peer countries. India also has a lower number of specialist doctors, especially in rural areas and community health centers as per statistics.

4. No Optimal Insurance

In India, healthcare is becoming more expensive and practically unaffordable to some strata of society. Hospitalization and treatment costs have skyrocketed. The only respite patients can get is through insurance. India’s per capita expenditure on insurance is the lowest in the world, about 30% when compared to over 80% in the west. Over 70% of Indians have to pay out of pocket for medical bills as they do not have insurance.

5. Less Emphasis on Preventive Care

Another major challenge facing Indian healthcare is the paucity of preventive care mechanisms. The lifestyle choices and hectic schedule of people do not allow them to watch their health. This unhealthy lifestyle and stress give way to diseases like diabetes and hypertension. It’s a given that the doctor-patient ratio in India is skewed. This makes it even more crucial to focus on preventive healthcare.

The healthcare industry shows more focus on reactive than proactive steps. Preventive healthcare helps to make consumers aware of their health and make smart and consistent choices on their lifestyle, diet, and general health. Preventive care helps tackle big problems at the early stage. Due to a lack of preventive healthcare facilities at hospitals, people are adopting home monitoring systems to assess their health.

6. Delay in Diagnosis of Illnesses

There are many incidents of delayed diagnosis of major illnesses even with top hospitals and doctors. The reasons for this are either lack of infrastructure to run lab tests or lack of accountability of the healthcare staff or the inability to convert the test results into proper treatment decisions. These lapses in the healthcare system cause the patients a lot of wasted time, cost, and mental trauma. Patients have the right to step in and ask a doctor about their current health status, diagnosis, and treatment plan.

7. No Support for Medical Research

Only research leads to true success in the healthcare of any country. Medicine and vaccine for infectious and chronic diseases need to be made accessible to all. Unfortunately, healthcare is at the mercy of big pharmaceutical companies who only deal with drugs that are profitable and essential drugs are neglected.

The main reason for the lack of research interest is the overburdening of the research staff and lack of resources. Most of the workforce in medical centers work long hours in continuous duty and have no time for the research component of their medical practice. For those who do commence with research, they lose continuity or do not get funding and support. Unfortunately, they are left to rely on medical data from other countries for prognosis and diagnosis.

8. Challenges Faced by Hospitals in India

There are plenty of issues in the private and public hospitals in India that are affecting the quality of services provided. Top on the list is inefficient workforce management.

Effective Strategies for Overcoming Healthcare Challenges

Medical staff having discussion in hospital. Healthcare workers, coronavirus and insurance concept
Medical staff having discussion in hospital
  • Ensure all vacant healthcare personnel positions, especially frontline staff, are filled in public hospitals.
  • Provision necessary medicines, vaccines, and equipment at primary health centers (PHCs), community health centers (CHCs), and district hospitals.
  • Support emergency feeding and community kitchens for people living with hunger and malnourishment.
  • Monitor and prioritize the improvement of Child Care Institutions (CCIs), Maa Gruha, mental health centers, and other facilities by the government and civil society organizations.
  • Promote and ensure adequate infrastructure and trained human resources for alternative systems of medicine like Ayurveda, Unani, and Homeopathy.
  • Train all frontline staff, including ANM, Aanganwadi workers, Supervisors, CDPOs, etc.
  • Establish more state-supported AIIMS-like hospitals in rural hinterlands and small towns and allocate more budgetary provisions (at least 8% of GDP) to the health sector.
  • Undertake more research on health issues, particularly lifestyle diseases, geriatric care, and water-borne diseases from a climate lens.
  • Promote innovative healthcare services and benefits to reach at-risk communities in remote tribal hinterlands.
  • Delink Aadhaar Card from health services and benefits.
  • Support innovation in healthcare, including disease control mechanisms and research for new medicines.
  • Explore novel business models in healthcare that are specific to the medical scene in India, such as patient assistance programs and social entrepreneurship.
  • Provide affordable healthcare access to the aging population, with benefits and discounts available to deserving senior citizens.
  • Promote mass awareness of treatment and health-seeking behavior, particularly among vulnerable and marginalized communities. Use Information education and communication (IEC) and Behavioral change communication (BCC) materials to disseminate information.
  • Carefully manage public health and safety issues by the government.
  • Allow insurance systems to penetrate healthcare to reduce the financial burden on patients.

Also read:

Ravi S. Behera
Ravi S. Behera
Mr. Ravi Shankar Behera, PGDAEM, National Institute of Agricultural Extension Management (MANAGE), Hyderabad is an independent freelance Consultant and Author based in Bhubaneswar. He is an Honorary Advisor to grassroots Voluntary Organizations on Food Security, Forest and Environment, Natural Resource Management, Climate Change and Social Development issues. Ravi has lived and worked in various states of India and was associated with international donors and NGOs over the last twenty three years including ActionAid, DanChurchAid, Embassy of Sweden/Sida, Aide et Action, Sightsavers, UNICEF, Agragamee, DAPTA and Practical Action. He has a keen interest in indigenous communities and food policy issues.
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